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Funding Acknowledgements Type of funding sources: None. Background Thermal ablation of atrial fibrillation (AF) by means of radiofrequency or cryo-balloon is usually performed under general anesthesia, deep sedation, or conscious sedation at operator’s discretion and based on the general condition of the patient. However, a standardized sedation protocol when performing a non-thermal ablation, such as pulsed-field ablation (PFA) through irreversible cellular electroporation, has not been well established. Purpose We report our preliminary experience of a general anesthesia in spontaneous respiration protocol with ketamine used at a high-volume center during ablation of AF with a new PFA system. Methods All consecutive patients (pts) undergoing AF ablation with PFA at our center were included. Our sedation protocol consists of intravenous administration of midazolam (1+1 mg), fentanyl (25+25+25+25 mcg/kg) at low doses before local anesthesia with lidocaine (200mg) administration. Patients underwent sedation under spontaneous respiration by administering oxygen (4-6 l/min) through a face mask with nasal cannula. Local anesthesia was performed before the percutaneous femoral venous access. Soon after the trans-septal puncture, heparin (1 mg/kg) and atropine (1 mg, to mitigate anticipated bradycardia) were injected, followed by a second bolus of midazolam (1 mg). Ketamine adjunct (1 mg/kg) was then injected about 5 minutes before the first PFA delivery which was titrated to effect based on patient’s condition, response and changes in vital signs (total ketamine adjunction of 2 mg/kg). For quantitative assessment the Numeric Rating Scale for Pain (NRS) was applied. For qualitative assessment a 3-levels satisfaction evaluation was retrieved. The ablation endpoint was PVI as assessed by entrance and exit block. Results Forty-two pts were included in this analysis (mean age of 66±9 years,72% were male, CHA2DS2VASc score=2 [IQR 1–3], median body mass index 24[20-48]kg/m2, 35% had respiratory diseases – e.g. asthma, OSAS, COPD –). At baseline, before sedation, mean systolic blood pressure was 140.5+20.1mmHg and mean oxygen saturation was 97.9+2.1%. PVI was achieved in all the patients. The number of PFA applications to reach PVI was 33.4+3 (time to PVI = 25+4min). In two cases additional PFA lesion sets were deployed outside the PVs. Lab occupancy time was 122±32min, skin-to-skin time was 78±35min and fluoroscopy time was 23±14min. All the patients achieved a NRS ≤ 3. Satisfaction level was found to be acceptable in all procedures by both the patient and the primary operator (Score equal to 0). No major procedure-related adverse events were reported. Conclusion The PFA procedure has a short execution time. The standardized anesthetic protocol with the administration of drugs with rapid onset and pharmacological offset at low doses was effective and safe with an optimal degree of patient and operator satisfaction.

International audience; PurposeThe purpose of this study was to assess the efficacy in terms of neck failure of an initial neck dissection before definitive chemoradiotherapy in N2-3 oropharyngeal squamous cell carcinomas, as well as the dosimetric impact and the acute and delayed morbidity of this approach.Materials and methodsAll patients consecutively treated between 2009 and 2018 with definitive chemoradiotherapy using intensity-modulated conformal radiotherapy (IMRT) for a histologically proven N2-3 oropharyngeal squamous cell carcinomas were retrospectively included. The therapeutic approach consisted of induction chemotherapy, followed by cisplatine-based chemoradiotherapy preceded or not by neck dissection. Neck dissection was discussed on a case-by-case basis in a dedicated multidisciplinary tumour board for patients with a dissociated response to induction chemotherapy, defined as a better response on the primary than on the node. Chemoradiotherapy without neck dissection was systematically performed in case of a major lymph node response to induction chemotherapy (decrease in size of 90% or more). Intensity-modulated radiotherapy using a simultaneous-integrated boost delivered 70 Gy in 35 fractions on macroscopic tumour volumes, 63 Gy on intermediate-risk levels or extra-nodal extension and 54 Gy on prophylactic lymph node areas.ResultsTwo groups were constituted: 47 patients without an initial neck dissection (62.7%), and 28 patients with a neck dissection prior to definitive chemoradiotherapy (37.3%). Initial patient characteristics were not statistically different between the two groups. The median follow-up was 60.1 months (range: 3.2–119 months). Incidence of neck failure was higher in patients without neck dissection (P = 0.015). The neck failure rate at 5 years was 19.8% (95% confidence interval: 7.4–30.6%; P = 0.015) without neck dissection versus 0% following neck dissection. All lymph node failures occurred in the planned target volume at 70 Gy. Upfront neck dissection suggested a decrease in the mean dose received by the homolateral parotid gland (P = 0.01), mandible (P = 0.02), and thyroid gland (P = 0.02). Acute toxicity of chemoradiotherapy after neck dissection suggested a reduction in grade ≥ 3 adverse events (P = 0.04), early discontinuation of concomitant chemotherapy (P = 0.009) and feeding tube-dependence (P = 0.008) in univariate analysis. During follow-up, there was no difference between the two groups in terms of xerostomia, dysgeusia, dysphagia or gastrostomy dependence in univariate analysis.ConclusionNeck dissection prior to definitive chemoradiotherapy in N2-3 oropharyngeal squamous cell carcinoma was associated with high neck control without additional mid and long-term morbidity.; Objectif de l’étudeIl s’agissait d’évaluer l’efficacité en termes d’échec ganglionnaire du curage ganglionnaire cervical initial dans les carcinomes épidermoïdes de l’oropharynx de stade N2-3 pris en charge par chimioradiothérapie exclusive, ainsi que l’impact dosimétrique et la tolérance aiguë et tardive de cette approche.Matériels et méthodesTous les patients consécutivement pris en charge entre 2009 et 2018 par chimioradiothérapie exclusive à l’aide d’une radiothérapie conformationelle avec modulation d’intensité (RCMI) pour un carcinome épidermoïde de l’oropharynx de stade N2-3 selon la septième édition de la classification TNM American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) ont été rétrospectivement inclus. La stratégie thérapeutique consistait en une chimiothérapie d’induction, suivie d’une chimioradiothérapie exclusive à base de cisplatine précédée ou non d’un curage ganglionnaire cervical. Le curage ganglionnaire cervical a été discuté au cas par cas en réunion de concertation multidisciplinaire dédiée chez les patients en situation de réponse dissociée à la chimiothérapie d’induction, à savoir une réponse de meilleure qualité sur la tumeur primitive que sur les ganglions. Une chimioradiothérapie sans curage ganglionnaire cervical a été systématiquement réalisée en cas de réponse ganglionnaire majeure à la chimiothérapie d’induction (diminution en taille de 90 % ou plus). La RCMI délivrait en boost intégré une dose de 70 Gy en 35 fractions dans les volumes tumoraux macroscopiques, 63 Gy dans les aires ganglionnaires à risque intermédiaire ou en rupture capsulaire et 54 Gy dans celles irradiées à visée prophylactique.RésultatsDeux groupes ont été constitués : 47 (62,7 %) patients sans curage ganglionnaire cervical initial, et 28 (37,3 %) patients avec un curage ganglionnaire cervical avant la chimioradiothérapie. Les caractéristiques initiales des patients n’étaient pas statistiquement différentes entre les deux groupes. Le recul médian était de 60,1 [3,2–119] mois. L’incidence des échecs ganglionnaires était plus élevée chez les patients n’ayant pas eu de curage ganglionnaire cervical (p = 0,015). Le taux d’échec ganglionnaire à 5 ans était de 19,8 % (intervalle de confiance à 95 % : 7,4–30,6) en l’absence de curage ganglionnaire cervical contre aucune rechute (0 %) après curage ganglionnaire cervical. Tous les échecs ganglionnaires se trouvaient dans le volume cible prévisionnel à 70 Gy. Le curage ganglionnaire cervical a permis une diminution de la dose moyenne reçue par la parotide homolatérale (p = 0,01), la mandibule (p = 0,02) et la thyroïde (p = 0,02). La tolérance aiguë de la chimioradiothérapie avait tendance à être meilleure chez les patients ayant eu un curage ganglionnaire avec une réduction des événements indésirables de grade ≥ 3 (p = 0,04), de l’arrêt précoce de la chimiothérapie concomitante (p = 0,009) et du recours à une gastrostomie (p = 0,008) en analyse unifactorielle. Au cours du suivi, il n’existait aucune différence entre les deux groupes en termes de xérostomie, de dysgueusie, de dysphagie ou de dépendance à la gastrostomie en analyse unifactorielle.ConclusionLe curage ganglionnaire cervical avant la chimioradiothérapie exclusive dans les carcinomes épidermoïdes de l’oropharynx de stade N2-3 était associé à un très bon taux de contrôle ganglionnaire sans morbidité supplémentaire à moyen et long termes.

By modifying the size and shape of the molecules, we managed to tune the hole mobility of our HTMs up to three orders of magnitude. Our best HTM led to a solar cell lifetime that is tripled compared to that based on spiro-OMeTAD.

When localized, the reference treatment of urothelial, muscle-invasive bladder tumours relies on radical cystectomy with reconstruction by enterocystoplasty if possible or Bricker bypass. Trimodal therapy combining transurethral resection of the tumour followed by concomitant chemotherapy may be considered as a therapeutic alternative to radical cystectomy in well-selected patients with unifocal tumours, stage T2, non-diverticular location, without in situ carcinoma or hydronephrosis and with macroscopically complete transurethral resection. The functional prognosis of the bladder and quality of life should be discussed with the patient as well as the need for salvage surgery for persistent tumour at a 45-Gy dose level, the latter being a highly unfavourable prognosis factor. On the other hand, this trimodal treatment is the reference in case of surgical contraindication. This article details the methods and results of the main series available in the literature in terms of local control, survival, bladder preservation rates and complications, as well as study prospects.

Stereotactic radiotherapy of oligometastases, mono- or hypofractionated, represents a fundamental change in the practice of the specialty as it was developed for a century. Despite the great heterogeneity of sites, techniques, and doses, most studies found a high local control rate, around 70 to 90% at 2 years, and reduced toxicity, around 5% of grade 3 at 2 years. Four main phase II and III trials are underway in France. Future research concerns the association of stereotactic radiotherapy with immunotherapy or different conventional chemotherapy protocols, the identification of the best clinical presentations, and optimization of fractionation and biological dose for poor prognosis localizations.

The purpose of this study was to assess the efficacy in terms of neck failure of an initial neck dissection before definitive chemoradiotherapy in N2-3 oropharyngeal squamous cell carcinomas, as well as the dosimetric impact and the acute and delayed morbidity of this approach.All patients consecutively treated between 2009 and 2018 with definitive chemoradiotherapy using intensity-modulated conformal radiotherapy (IMRT) for a histologically proven N2-3 oropharyngeal squamous cell carcinomas were retrospectively included. The therapeutic approach consisted of induction chemotherapy, followed by cisplatine-based chemoradiotherapy preceded or not by neck dissection. Neck dissection was discussed on a case-by-case basis in a dedicated multidisciplinary tumour board for patients with a dissociated response to induction chemotherapy, defined as a better response on the primary than on the node. Chemoradiotherapy without neck dissection was systematically performed in case of a major lymph node response to induction chemotherapy (decrease in size of 90% or more). Intensity-modulated radiotherapy using a simultaneous-integrated boost delivered 70Gy in 35 fractions on macroscopic tumour volumes, 63Gy on intermediate-risk levels or extra-nodal extension and 54Gy on prophylactic lymph node areas.Two groups were constituted: 47 patients without an initial neck dissection (62.7%), and 28 patients with a neck dissection prior to definitive chemoradiotherapy (37.3%). Initial patient characteristics were not statistically different between the two groups. The median follow-up was 60.1months (range: 3.2-119months). Incidence of neck failure was higher in patients without neck dissection (P=0.015). The neck failure rate at 5years was 19.8% (95% confidence interval: 7.4-30.6%; P=0.015) without neck dissection versus 0% following neck dissection. All lymph node failures occurred in the planned target volume at 70Gy. Upfront neck dissection suggested a decrease in the mean dose received by the homolateral parotid gland (P=0.01), mandible (P=0.02), and thyroid gland (P=0.02). Acute toxicity of chemoradiotherapy after neck dissection suggested a reduction in grade≥3 adverse events (P=0.04), early discontinuation of concomitant chemotherapy (P=0.009) and feeding tube-dependence (P=0.008) in univariate analysis. During follow-up, there was no difference between the two groups in terms of xerostomia, dysgeusia, dysphagia or gastrostomy dependence in univariate analysis.Neck dissection prior to definitive chemoradiotherapy in N2-3 oropharyngeal squamous cell carcinoma was associated with high neck control without additional mid and long-term morbidity.

Additional file 5: Dataset S5. Phylogenetic analysis of strain UYP1. A Neighbor joining tree was constructed using 16S rRNA nucleotide sequences of fifteen Pedobacter type strains retrieved by EZBioCloud (highlighted in bold) and fifteen strains retrieved by RDP and downloaded from NCBI e-servers, as most similar in sequence with UYP1. Pedobacter sp. UYP1 phylogenetic position is indicated by an arrow. Accession numbers for all the strains are detailed in brackets.

Additional file 4: Dataset S4. 16S rRNA similarity search results.

Additional file 1: Dataset S1. Production of H2S and bacterial growth in medium with Cd2+ of the lithobiont collection.

Additional file 3: Dataset S3. Tolerance of strain UYP1 of different metal salts.

Additional file 6: Dataset S6. H2S(g) liberation assay. White filter paper was moistened with a 0.1 M lead acetate solution, air-dried and attached to the lid of tubes with different conditions. H2S(g) liberation was therefore assessed according to the lead acetate method [46]. (a) Negative control (R2A medium) with or without 1 mM cysteine and Pedobacter sp. UYP1 strain grown in R2A medium, with or without 1 mM cysteine. (b) Relative intensity values obtained from the pixel intensity analysis of the images in a.

To evaluate trimodal conservative treatment as an alternative to radical surgery for urothelial muscle-invasive bladder cancer (MIBC). This retrospective study reported the carcinologic and functional results of patients (pts) presenting a cT2/T3 N0M0 operable MIBC and fit for surgery, treated by a conservative strategy. Treatment consisted of a transurethral resection (TURB) followed by concomitant bi-fractionated split-course radiochemotherapy (RCT) with 5FU-Cisplatine. A control cystoscopy was performed six weeks after the induction RCT (eq45Gy) with systematic biopsies. Patients with complete histologic response achieved RCT protocol. Salvage surgery was proposed to pts with persistent tumor. 313 pts (83% cT2 and 17% cT3) treated between 1988 and 2013 were included, with a median follow-up of 59 months and 67-year mean age. After the induction RCT, the histologic response rate was 83%. After five years, overall, disease-free, and functional bladder-intact survival rates were respectively 69%, 61%, and 69%, significantly better for pts in complete response after induction RCT. Late urinary and digestive toxicities were limited, with respective rates of 4% and 1.5% of grade 3 toxicity. Trimodal strategy with RCT after TURB showed interesting functional and oncologic results and should be considered as an alternative to surgery in well-selected pts.

BACKGROUND: FOLFIRINOX has shown promising results in locally advanced (LAPA) or borderline resectable (BRPA) pancreatic adenocarcinoma. We report here a cohort of patients treated with this regimen from the AGEO group. METHODS: This is a retrospective multicentre study. We included all consecutive patients with non-pre-treated LAPA or BRPA treated with FOLFIRINOX. RESULTS: We included 330 patients (57.9% male, 65.4%

Objective This study assessed outcomes of inoperable endometrial cancer (IEC) patients treated with definitive external beam radiation therapy (EBRT) followed by a 3D image-guided brachytherapy boost. Methods All consecutive patients treated with EBRT followed by 3D image-guided brachytherapy for IEC were retrospectively included. EBRT delivered a dose of 45Gy. Then, patients had an uterovaginal brachytherapy guided by 3D imaging. Clinical target volume (CTVBT) included the whole uterus and the initial disease extent. Gross tumour volume (GTVres) included the residual disease at time of brachytherapy. Results Twenty-seven patients were identified. Causes of inoperability were comorbidities (37%) or tumour loco regional extent (63%). Including EBRT and brachytherapy, the median D90 (minimal dose delivered to 90% of the volume) was 60.7 GyEQD2 (IQR = 56.4–64.2) for the CTVBT, and was 73.6 GyEQD2 (IQR = 64.1–83.7) for the GTVres. The median overall treatment time was 50 days (IQR = 46–54). The mean follow-up was 36.5 months (SD = 30.2). The cumulative incidence of local, pelvic and distant failures was 19% (n = 5), 7% (n = 2) and 26% (n = 7), respectively. Five-year overall survival was 63% (95% CI = 43–91). Late urinary and gastro intestinal toxicities ≥ grade 2 were reported in four (15%) and two patients (7%) respectively. No vaginal toxicity ≥ grade 2 was reported. Conclusions EBRT followed by intracavitary brachytherapy seems to be an effective option for IEC. The implementation of 3D concepts at time of brachytherapy may contribute to high local control probability and low toxicity profile. Large scale retrospective or prospective data are needed to confirm these early data.

Résumé De nouveaux concepts de consultations sont actuellement en train de profondément changer la façon d’exercer la médecine. L’utilisation de questionnaires standardisés, des questionnaires patients (PRO, patient-reported outcome, et son application informatique, ePRO) ont déjà fait irruption dans nos consultations. En parallèle, la télémédecine, voire l’utilisation d’agents conversationnels automatiques médicaux, permettent d’assurer une consultation à distance, plus accessible. Ces différents outils ont un intérêt majeur en oncologie, notamment dans le contexte de la chronicisation des maladies et du suivi à long terme que les oncologues radiothérapeutes prennent en charge. Dans cet article, nous détaillons chacun de ces nouveaux concepts.

International audience; De nouveaux concepts de consultations sont actuellement en train de profondément changer la façon d’exercer la médecine. L’utilisation de questionnaires standardisés, des questionnaires patients (PRO, patient-reported outcome, et son application informatique, ePRO) ont déjà fait irruption dans nos consultations. En parallèle, la télémédecine, voire l’utilisation d’agents conversationnels automatiques médicaux, permettent d’assurer une consultation à distance, plus accessible. Ces différents outils ont un intérêt majeur en oncologie, notamment dans le contexte de la chronicisation des maladies et du suivi à long terme que les oncologues radiothérapeutes prennent en charge. Dans cet article, nous détaillons chacun de ces nouveaux concepts

Objectifs Avec un âge median de 73 ans au diagnostic, le cancer de vessie touche frequemment les sujets âges. Or leur prise en charge n’est pas consensuelle, la chirurgie n’etant pas toujours possible lorsqu’il existe des elements de fragilite geriatrique. Le traitement trimodal (TMT) associant resection trans-uretrale (RTUV) puis radiochimiotherapie serait une alternative curative permettant la preservation de la vessie native. Methodes De 1988 a 2017, les patients (pts) des 75 ans ayant une tumeur de vessie infiltrant le muscle (T2-T3N0M0), traitees par TMT ont ete analyses. Le traitement comportait une RTUV suivie d’une radiotherapie HF2SQ pelvienne (3 Gy matin et soir J 1J 3J 15J 17) puis vesicale (2,5 Gy matin et soir J 29J 31 J 42J 44 chez les inoperables et a partir de la semaine 6 chez les operables, apres cystoscopie de controle), en concomitance avec une chimiotherapie par 5 FU et sels de platine. Les pts operables avaient une cystoscopie 5 semaines apres le temps pelvien. Les pts en reponse complete recevaient le complement vesical, les non-repondeurs avaient une cystectomie de rattrapage. Resultats Quatre-vingt-cinq patients (âge median 80 ans), de stade T2 et T3 ont ete selectionnes. Apres induction, le taux de reponse complete etait de 83 %. La survie globale (SG), specifique (SS), sans maladie infiltrante (SSMI) et sans metastase (SSM) a 3 ans etaient de 72 %, 82,5 %, 78,4 % et 84,9 %, a 5 ans de 61 %,77 %, 71,6 % et 82,9 % respectivement. Le taux de survie vessie preservee (SVP) etait de 70 % a 5 ans. Un ACCI > 6 (HR 0,3 ; p = 0,044) et une denutrition (HR 1,9 ; p = 0,032) ont impacte significativement la SG, la SS et la SSM. Un residu tumoral apres induction etait deletere sur la survie : SS (HR 3,6 ; p = 0.008), SSM (HR 3,6 ; p = 0,018) et SVP (HR 3,3 ; p = 0,003). Les toxicites tardives grade ≥ 3 urinaire et gastro-intestinale etaient de 2,6 % et 1,3 %. Conclusion Nous rapportons la plus grande serie de preservation vesicale des sujets de plus de 75 ans. La denutrition, un score de Charlson ajuste a l’âge > 6 et la presence d’un reliquat tumoral apres la phase d’induction sont des facteurs pronostiques defavorables. Le TMT avec l’IHF2SQ semble efficace et bien tolere chez des sujets âges selectionnes.

Objectifs Le traitement trimodal (TTM) des tumeurs de vessie infiltrant le muscle (TVIM) est une alternative a la cystectomie chez des patients selectionnes. En cas de recidive non infiltrante apres reponse complete au TTM, la prise en charge optimale reste a preciser. L’objectif de cette etude etait d’evaluer l’incidence, les facteurs de risque, la prise en charge et l’evolution des recidives non invasives apres TTM. Methodes Il s’agit d’une etude retrospective, multicentrique, incluant 259 patients, eligibles a la cystectomie, en reponse complete apres TTM (irradiation hypo fractionnee avec 2 seances quotidiennes), pour une TVIM cT2-3 N0-x M0, pris en charge entre 1988 et 2013, dans trois centres francais. Nous avons analyse l’association entre les variables clinico-pathologiques et l’evolution naturelle des recidives non infiltrantes. La survie a ete analysee selon Kaplan–Meier, et les analyses comparatives par Test du Log-Rank. Resultats Apres un suivi median de 7 ans, 30 patients (12 %) en reponse complete apres TTM, ont presente une recidive non infiltrante, parfois dans un delais superieur a 10 ans. Un tiers de ces patients ont eu une cystectomie de rattrapage. Il n’y avait pas de difference en survie globale (p = 0,64) entre les patients traites par traitement radical et ceux traites par traitement conservateur. En cas de traitement conservateur, 4 patients (13 %) ont evolue vers une forme infiltrante. L’existence d’une TVNIM a haut risque etait le seul facteur clinico-pathologique associe au risque de nouvelle recidive (p = 0,05). Douze patients (40 %) ont recu un traitement d’induction par BCG, avec une toxicite acceptable (6 %), et une amelioration de la survie sans recidive (p = 0,033), sans incidence sur la survie globale (p = 0,18). Conclusion Apres reponse complete au TTM, 12 % des patients ont presente une recidive non infiltrante. Ces lesions semblent avoir les memes facteurs pronostiques que les TVNIM. Un traitement local, associe a des instillations de BCG presente un profil de toxicite acceptable, tout en diminuant le risque de nouvelle recidive et semble une alternative raisonnable au traitement radical chez des patients selectionnes.

Stereotactic radiotherapy represents a fundamental change in the practice of radiotherapy of lung cancers. Despite the great heterogeneity of sites, techniques, and doses, most studies found a high local control rate, around 70 to 90% at 2 years, and reduced toxicity, around 5% of grade 3 at 2 years. Stereotactic radiotherapy can be realized either by a dedicated accelerator (CyberKnife®) or by a conventional accelerator associated with specific systems. The two modalities deliver a very precise irradiation whose very good results published to date are similar. Some technical characteristics specific to each type of linear accelerator could guide the choice according to the target volume treated.

Stereotactic radiotherapy represents a fundamental change in the practice of radiotherapy of lung cancers. Despite the great heterogeneity of sites, techniques, and doses, most studies found a high local control rate, around 70 to 90% at 2 years, and reduced toxicity, around 5% of grade 3 at 2 years. Stereotactic radiotherapy can be realized either by a dedicated accelerator (CyberKnife

Stereotactic radiotherapy of oligometastases, mono- or hypofractionated, represents a fundamental change in the practice of the specialty as it was developed for a century. Despite the great heterogeneity of sites, techniques, and doses, most studies found a high local control rate, around 70 to 90% at 2 years, and reduced toxicity, around 5% of grade 3 at 2 years. Four main phase II and III trials are underway in France. Future research concerns the association of stereotactic radiotherapy with immunotherapy or different conventional chemotherapy protocols, the identification of the best clinical presentations, and optimization of fractionation and biological dose for poor prognosis localizations.

When localized, the reference treatment of urothelial, muscle-invasive bladder tumours relies on radical cystectomy with reconstruction by enterocystoplasty if possible or Bricker bypass. Trimodal therapy combining transurethral resection of the tumour followed by concomitant chemotherapy may be considered as a therapeutic alternative to radical cystectomy in well-selected patients with unifocal tumours, stage T2, non-diverticular location, without in situ carcinoma or hydronephrosis and with macroscopically complete transurethral resection. The functional prognosis of the bladder and quality of life should be discussed with the patient as well as the need for salvage surgery for persistent tumour at a 45-Gy dose level, the latter being a highly unfavourable prognosis factor. On the other hand, this trimodal treatment is the reference in case of surgical contraindication. This article details the methods and results of the main series available in the literature in terms of local control, survival, bladder preservation rates and complications, as well as study prospects.

Hemorrhage is the leading preventable cause of death in civilian and military trauma. Recent data from the ongoing conflicts in Iraq and Afghanistan suggest that early and aggressive tourniquet utilization is a safe and effective way to dramatically reduce mortality from extremity hemorrhage. As a result, prehospital tourniquet use is now endorsed by a majority of professional emergency medicine, emergency medical service and trauma professional societies. However, there currently exists scant evidence supporting the efficacy of commercially available tourniquets in controlling extremity hemorrhage in pediatric trauma patients.

Objectif de l’etude Evaluer une strategie alternative a la chirurgie radicale par traitement trimodal conservateur dans les carcinomes urotheliaux de la vessie localises infiltrants le muscle. Materiel et methode Il s’agissait d’une etude retrospective rapportant les resultats carcinologiques et fonctionnels des patients atteints d’un carcinome urothelial de la vessie localise infiltrant le muscle de stade cT2/T3 operable, traite selon une strategie conservatrice. Le traitement comportait une resection transuretrale vesicale la plus complete possible, suivie d’une chimioradiotherapie concomitante bifractionnee en split-course avec une chimiotherapie par 5-fluoro-uracile et cisplatine. Une cystoscopie de controle avec biopsies systematiques a ete realisee 6 semaines apres la fin de la chimioradiotherapie initiale : les patients en situation de reponse histologique complete poursuivaient le protocole de chimioradiotherapie tandis que les autres avaient une chirurgie de rattrapage. Resultats Les 313 patients pris en charge (pour 83 % de tumeur de stade cT2, 17 % cT3) entre 1988 et 2013 ont ete inclus dans cette etude, avec un suivi median de 59 mois et un âge moyen de 67 ans. Le taux de reponse complete histologique a mi-traitement etait de 83 %. A 5 ans, les probabilites de survie globale, sans maladie, sans metastase et avec une vessie fonctionnelle etaient respectivement de 69 %, 61 %, 73 % et 69 % significativement meilleures chez les patients en situation de reponse complete apres la chimioradiotherapie d’induction. La toxicite tardive urinaire et digestive etait limitee, avec respectivement 3,2 % et 1,3 % de cas de grade 3, aucun cas de grade 4 ou 5. Conclusion La prise en charge conservatrice par resection transuretrale vesicale puis chimioradiotherapie a donne des resultats carcinologiques satisfaisants chez des patients bien selectionnes, avec un bon resultat fonctionnel et constitue donc un traitement de choix, en particulier chez les sujets âges ou avec de nombreuses maladies associees.

Earlier work on stream water and effluent from wastewater treatment plants in Blantyre, Malawi, has revealed high phosphate levels ranging from 0.63 to 5.50 mg/L. These phosphate levels would stimulate excessive growth of plants and toxic cyanobacteria in stagnant receiving water bodies hence posing a threat to aquatic life and water quality. Phosphate removal by kaolinite obtained from Linthipe, Malawi, was investigated as a function of pH, contact time, clay dosage, competing ions and initial phosphate concentration by means of jar tests. Phosphate uptake was pH dependent with adsorption mechanisms on kaolinite and iron oxide surfaces dominant generally below pH 7 and precipitation by calcium ions dominant above pH 7. Maximum phosphate removal occurred at high pH values of 11.22 (97.1%) and 10.96 (100%) for raw and treated kaolinite, respectively. Acid treated kaolinite indicated higher phosphate removal efficiency than the raw one at the normal working pH of 9.0 ± 0.2. This was attributed to release of extra calcium ions from CaCO 3 present in the kaolinite samples during acid treatment. At the maximum dosage of 80 g/L, percent phosphate removal was 69.7 ± 0.100% and 98.5 ± 0.0577% for raw and treated kaolinite, respectively. This indicates requirement for high dosages to effect phosphate removal from the aqueous solutions. Studies on the effects of competing ions indicate that phosphate uptake decreased in the presence of CO 3 2 - , was little affected by SO 4 2 - , and increased in the presence of Ca 2+ , and Mg 2+ ions. Furthermore, phosphate uptake approached equilibrium slowly at 20 °C and was faster at 40 °C.

This study assessed the ability of filamentous green algae; Spirogyra aequinoctialis to accumulate manganese, cadmium and lead from water. Water pH was also determined. Samples of S. aequinoctialis and their respective water environments were taken from designated sampling points in the city of Blantyre and Malawi during the rainy and dry season in order to capture seasonal variations. The concentration of metals in S. aequinoctialis were higher than in the corresponding water environment in both seasons, but lower in the rainy season than the dry season. In the rainy season the concentrations were (in S. aequinoctialis and (water)): Mn 0.432–5.641 mg/L (ND-0.530 mg/L), CdND- 0.016 mg/L (0.07–0.111 mg/L) andPbND- 0.965 mg/L (0.011–0.098 mg/L). In the dry season the concentrations were: Mn 0.281-16.132 mg/L (0.035–0.626 mg/L), Cd 0.22–0.912 mg/L (0.014–0.111 mg/L) and Pb ND- 0.972 mg/L (ND- 0.23 mg/L). This study has shown that S. aequinoctialis has the capability of accumulating manganese, cadmium and lead. Therefore it can be used as a biological indicator for long term heavy metal water pollution monitoring.

A study was carried out to determine fluoride concentration in groundwaters of Nathenje area situated in Lilongwe District in the central region of Malawi. Water samples were collected from 176 boreholes and shallow wells during different months in 2001 and 2002. Samples were then analysed for fluoride by using a fluoride electrode and an ion selective meter. The results showed that fluoride concentrations for the rainy season varied from

Using the observed proportionality of CCSD(T) and MP2 correlation interaction energies [I. Grabowski, E. Fabiano, F. Della Sala, Phys. Chem. Chem. Phys. 15, 15485 (2013)] we propose a simple scaling procedure to compute accurate interaction energies of non-covalent complexes. Our method makes use of MP2 and CCSD(T) correlation energies, computed in relatively small basis sets, and fitted scaling coefficients to yield interaction energies of almost complete basis set limit CCSD(T) quality. Thanks to the good transferability of the scaling coefficients involved in the calculations, good results can be easily obtained for different intermolecular distances., Comment: 8 pages, 4 figures

The performance of correlated optimized effective potential (OEP) functionals based on the spin-resolved second-order correlation energy is analyzed. The relative importance of singly- and doubly- excited contributions as well as the effect of scaling the same- and opposite- spin components is investigated in detail comparing OEP results with Kohn-Sham (KS) quantities determined via an inversion procedure using accurate ab initio electronic densities. Special attention is dedicated in particular to the recently proposed scaled-opposite-spin OEP functional [I. Grabowski, E. Fabiano and F. Della Sala, Phys. Rev. B, 87, 075103, (2013)] which is the most advantageous from a computational point of view. We find that for high accuracy a careful, system dependent, selection of the scaling coefficient is required. We analyze several size-extensive approaches for this selection. Finally, we find that a composite approach, named OEP2-SOSh, based on a post-SCF rescaling of the correlation energy can yield high accuracy for many properties, being comparable with the most accurate OEP procedures previously reported in the literature but at substantially reduced computational effort., 14 pages, 4 figures

We performed a benchmark study on a series of dihydrogen bond complexes and constructed a set of reference bond distances and interaction energies. The test set was employed to assess the performance of several wave-function correlated and density functional theory methods. We found that second-order correlation methods describe relatively well the dihydrogen complexes. However, for high accuracy inclusion of triple contributions is important. On the other hand, none of the considered density functional methods can simultaneously yield accurate bond lengths and interaction energies. However, we found that improved results can be obtained by the inclusion of non-local exchange contributions., 15 pages, 7 figures

The intramolecular radiative and nonradiative relaxation processes of three thiophene-S,S-dioxide derivatives with different molecular rigidity are investigated in different solutions and in inert matrix. We show that the fluorescence quantum efficiency and the relaxation dynamics are strongly dependent on the environment viscosity, whereas they are almost independent of the environment polarity. We demonstrate that this strong dependence is due to an environment dependent nonradiative decay rate, whereas no relevant variations of the radiative decay rate are observed. We demonstrate that the dipole coupling with the solvent does not provide an efficient nonradiative decay channel and that the Sn - S1 vibrational relaxation is very efficient in all of the molecules and for all of the investigated environments. Moreover first-principles time-dependent density-functional theory calculations in the correct, i.e., excited-state, molecular conformation, suggest that significant contributions of intersystem crossing to the triplet manifold can be excluded. We then conclude that the main nonradiative process determining the fluorescence quantum efficiency of this class of molecules is S1 - S0 internal conversion (IC). An explanation for the IC rate dependence in terms of the environment viscosity, molecular rigidity, S1 - S0 energy-gap, and molecular volume is presented.

In this chapter we present an introductory overview of the basic theoretical concepts of computational molecular photophysics. First, the nature and properties of electronic excitations are considered, with special attention to transition moments and vibrational contributions. Then, the main photophysical processes involving the electronic excited states are examined, focusing in particular on nonradiative deactivation phenomena. Finally, we present a brief review of computational methods commonly applied for the description of molecular excitations. Special emphasis is given to the configuration interaction method and the time-dependent density functional theory, discussing some technical details and outlining advantages and limitations.